Hipertensão Portopulmonar e Gravidez

A gravidade da coexistência de hipertensão pulmonar e gravidez está bem estabelecida. A hipertensão arterial pulmonar constitui condição com elevado risco de morte materna no final da gravidez e pós-parto. Pacientes portadores de hipertensão portal de várias etiologias podem desenvolver hipertensão arterial pulmonar (hipertensão portopulmonar), sendo a maioria dos casos relatados na cirrose hepática, entretanto uns poucos casos foram descritos na hipertensão portal não cirrótica. São apresentados o quadro clínico e anatomopatológico em dois casos de hipertensão portopulmonar e gravidez. Tratava-se de pacientes com 30 e 24 anos de idade, que desenvolveram insuficiência cardíaca direita grave e choque no puerpério imediato, evoluindo rapidamente para o óbito. A necropsia demonstrou em ambos os casos fibrose nos espaços portais, correspondendo ao relatado na hipertensão portal idiopática, além de hipertensão pulmonar classificada como plexogênica

Hypovitaminosis D is associated with visceral adiposity, high levels of low-density lipoprotein and triglycerides in alternating shift workers.

Background: Studies suggest that there is a strong association between low vitamin D levels and cardiovascular disease (CVD) and its risk factors (RFs). Hypovitaminosis D (25(OH)D < 30 ng/mL or 75 nmol/L) is a recent public health problem that has reached different populations. The objective of the study was to investigate whether hypovitaminosis D is an additional mechanism to explain the disturbances in the lipid profile as well as the excess of abdominal fat presented by alternating shift workers of a mining company in the region of Inconfidentes, Minas Gerais, Brazil. Methods: A cross-sectional study was conducted in a sample of 391 adult males, aged 20 - 57 years old and working alternating shifts, who had at least one risk criterion for CVD. Demographic, behavioral, clinical, and anthropometric and body composition variables were obtained. A blood sample was drawn for determining 25(OH) D, parathyroid hormone intact molecule, lipid profile, blood glucose, insulin, C-reactive protein, and adipokines. Results: The average age of the 391 study participants was 36.1 ± 7.3 years. The percentage of hypovitaminosis D and dyslipidemia was 73% and 74.2%, respectively. Excess visceral fat was significant in the hypovitaminosis D group, with an odds ratio (OR) of 2.4 (95% confidence interval (CI): 1.1 - 5.2). Dyslipidemia showed 25(OH)D levels significantly lower (OR: 2.7, 95% CI: 1.6 - 4.3) than in individuals with normal levels of cholesterol and fractions, and triglycerides. After adjusted the analysis by age and seasonality, the vitamin levels had a significant inverse association and dose-dependent with lowdensity lipoprotein (OR: 5.9), triglycerides (OR: 2.3) and visceral fat area (OR: 2.4). Conclusion: Hypovitaminosis D and dyslipidemia were found in the majority of our mining company shift workers. Furthermore, excess visceral adiposity, hypertriglyceridemia and high low-density lipoprotein cholesterol levels are strong predictors of hypovitaminosis D